The women who received care at Washington State’s Cedar River Clinics’ Yakima clinic (originally called the Feminist Women’s Health Center) over the last 30 years are, as clinic manager Becky Cavender says, “…from all walks of life. They are mothers, sisters, nieces, cousins. They are teachers, students, ministers, doctors, lawyers, farm workers, and home-makers.”

But this week the mothers, sisters, teachers, ministers, and farm workers will have one less option when it comes to choosing a reproductive health provider as the Yakima clinic closes its doors and ends an era.

The Feminist Women’s Health Center of Washington State opened its first non-profit clinic in 1979 with $3000 and furniture from the founders’ homes, in the city of Yakima. The center’s aim was to not only offer what they called, at the time, “self help” (personal empowerment through knowledge, ladies!) but also to provide abortion and other health care for women from around the state and throughout the Pacific Northwest. Opening day was delayed because Mount St. Helens erupted, spewing ash across the city but the center eventually opened to women across the state. The reproductive and sexual health care provided was distinctly feminist with a focus on ensuring that each woman retained decision making power over her body and her care – care which was as supportive, woman-focused and non-judgmental as possible. Feminist health clinics were engaging in radical health provision for the time – allowing women to do their own pregnancy tests and offering group counseling sessions.

Over the years the center (renamed “Cedar River Clinics” in 2004) grew to three locations (after one location closed after repeated firebombings) around the state, serving thousands of women each year.

Founders Beverly Whipple and Deborah Lazaldi opened the health center with the intent to provide safe abortion care to local women. Whipple and Lazaldi rode a wave of feminist health care which began to swell after the passage of Roe v. Wade and women awakened to the idea that reproductive and sexual health care could (and should) be based in respect, empowerment and support; even abortion care. Health centers actually run by women, for women, opened their doors and pioneered practices like informed consent promoting the ideals that education, knowledge and access to care were necessary steps towards equality and justice for women. This all came with risks, of course. Over the years, the clinic staff women have received death threats, experienced violent attacks and numerous protests.

For years, the Yakima clinic was the only one of its kind in the area. Yakima County’s primary industry is agriculture; specifically commercial fruit production. The area receives 300 days of sunshine – a very different world from the ever-present rainy, gray weather further to the West. It’s an area that is home to many migrant workers who flood the area each year in search of low paying work. Vineyards and fruit orchards abound and they are need of migrant labor.

Cedar River Clinics’ Yakima clinic offered women migrant workers not only access to affordable health care – but to feminist-centered, supportive, personalized, non-judgmental care as well. But, of course, they offered this care to all of the women they saw. The center provided family planning, contraception, annual exams, sexually transmitted infection testing and more. But the clinic also was the only abortion provider for miles around who offered second trimester abortions – up to 22 weeks.

And while Planned Parenthood will continue to provide care to the women of the region, Whipple says it’s Planned Parenthood which is, in part, responsible for the independent, feminist health center’s closure:

“We would not be closing today if Planned Parenthood had not started providing abortion services in the same town where we have been providing abortion care for 30 years. In starting to provide abortion, they were NOT responding to a local need. Their actions did NOT expand access. We made a difficult decision, one that is responsible.”

Feminist women’s health centers may be a dying breed. Of the over fifty or so operating over the years, only fourteen remain. Six years ago, independently operated, feminist health centers decided to band together as the Feminist Abortion Network (FAN) to provide support and assistance to each other, across the country. In 2007, I explored whether feminist health care centers would be able to survive, after the closure of the clinic for which I worked. In 2009, in an interview with two of the FAN clinic staff women (one of whom, Joan Schrammeck, works with Cedar River Clinics) about the origin of the network, they told me, “It is worth mentioning how struck we were by the number of [feminist health centers] that over the last decade either closed or were left with no viable alternative other than merger.”

But, why? What makes feminist health centers so vulnerable and what does Planned Parenthood have to do with it (if anything)?

The answer is complex and probably not exact either. For many years, FWHC referred local women to the Yakima Planned Parenthood for birth control and likewise, Planned Parenthood referred women from throughout Central Washington to FWHC for abortion. It is when PP added abortion services a few years ago, then expanded them to offer second trimester abortions, that sustaining the FWHC Yakima clinic was untenable, notes Cedar River Clinics.

Planned Parenthood is, of course, a large entity providing care through health centers operating around the country, to millions of women. They do receive federal funding because, unlike the smaller centers which would need a much more complex accounting system to keep separate any potential government funding for family planning provision from the centers’ abortion provision, Planned Parenthood is able to separate the funding streams.

That said, feminist health centers are locally-grown, small businesses at heart. And just like any small business, they fall prey to a variety of factors from increased competition from larger-sized providers to a challenging economic environment. Of course, feminist health centers face much more than do most run-of-the-mill local businesses. They are, for the most part, political organizations in that they do not only provide care but they must lobby and fight for laws and policies which keep abortion care legal. The centers exist in an embattled environment where they must fight for their very existence – including for the lives of their staff women. They compete in an extremely competitive funding environment; many foundations don’t want to fund smaller, more regional reproductive rights groups – especially not care providers who they may see as not making the impact, policy wise, that single advocacy or large scale, national groups like Planned Parenthood do. Ironically, they are, at the same time, devoted to never turning a woman away for lack of funds, ensuring that all women in the community receive care. While many providers will no longer see Medicaid patients because of impossibly low reimbursements from the government, the mission driven feminist health centers continue to accept women using Medicaid for annual exams, pap smears and more. This all translates to centers literally giving away thousands of dollars in care each year. That’s not sustainable without immense support from the public.

When it comes down to it, the Yakima clinic closure is a loss for women, says Sasha Summer Cousineau, Board President of the CAIR Project, Washington state’s abortion fund for women-in-need.

“We’re really very, very sad. The CAIR Project works with Cedar River Clinics’ in Yakima regularly because…most of the women we serve are from Oregon, Idaho and the Yakima region.” As an abortion fund which raises money for low-income women’s abortions, the CAIR Project serves “the poorest of the poor women who fall through the hoops. They can’t afford to pay for an abortion and they are not eligible for any other health care assistance,” Cousineau tells Rewire.

For women who are desperately in need of an abortion and cannot afford one without financial assistance, Cedar River Clinics is their best hope. The center, says Cousineau, “still provides high quality care at a slightly lower price [than Planned Parenthood]. The difference between $400 and $450 for an abortion, if you don’t have the money, may as well be a million dollars. For the women we [the CAIR Project] serve, this makes all the difference in the world.”

As well, Cedar River Clinics engages in a great deal of client advocacy. When a woman’s primary language is something other than English or she’s experienced domestic violence or is in need of other resources or referrals, the clinic staff “jump through hoops” to connect her to services.

Cousineau calls Planned Parenthood a “wonderful ally,” though, and looks forward to the organization instituting a more robust “women-in-need” fund of their own so that women from around the Northwest can still access abortion care.

The Feminist Abortion Network says that you’ve got the women’s health movement to thank if “you participated in informed consent; read a package insert on the risks and benefits associated wtih oral contraceptives, hormone replacement therapy, or another pharmaceutical; your partner or support person attended your medical appointment with you as your advocate; you purchased an over-the-counter vaginal remedy or pregnancy test; or you were offered the opportunity to look at your cervix with a mirror during a gynecological exam.” The women’s health movement leaves a living legacy in its wake but the remaining feminist health centers aren’t about to give up.

Anita Kuennen, executive director of Montana’s Blue Mountain Clinic and president of the Feminist Abortion Network calls the closing, “… a wake-up call to all who support access to choice and access to health care,” and urges those who support this type of care to donate to a local, independent, non-profit clinic. The larger questions, however, remain. Are grassroots, locally-run, feminist health centers still viable? And if not, who will pick up the baton and run with it?

If this most recent closure is a wake-up call, I think we’ve hit snooze one too many times.